Advanced Versus Basic Life Support in the Pre‐Hospital Setting – The Controversy between the ‘Scoop and Run’ and the ‘Stay and Play’ Approach to the Care of the Injured Patient

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Abstract
Pre‐hospital care for trauma patients is provided by emergency medical personnel using either basic life support (BLS) or advanced life support (ALS) techniques. BLS for the seriously injured trauma patient most notably involves ‘scoop and run’ in which medical interventions are performed while en route to an appropriate hospital. These interventions are non‐invasive and include wound dressing, immobilization, fracture splinting, oxygen administration and non‐invasive cardiopulmonary resuscitation. ALS encompasses all of the previously mentioned BLS techniques in addition to minimally invasive procedures such as endotracheal intubation, intravenous access for fluid replacement and administration of medications. System protocols often dictate that ALS providers ‘stay and play’ at the scene of a serious trauma in order to carry out these more advanced procedures. The rationale for the use of on‐site ALS in trauma is that these interventions will reduce the rate of physiological and haemodynamic deterioration, thus stabilizing the patient prior to arrival at the hospital. It is expected that this will subsequently result in increased chances of survival. The paradox is that on‐site ALS increases the amount of time that is spent on the scene, and hence increases the delay to definitive in‐hospital care. The controversy regarding the pre‐hospital care of trauma patients between ALS and BLS is ongoing. Due to this unresolved controversy, as well as historical, cultural and political factors, significant variations exist in the pre‐hospital care available to trauma patients. Pre‐hospital care throughout the world is therefore inconsistent and is provided in different ways by different crews with different equipment, protocols and training. This review will focus on the controversies which occur in the urban setting with regard to the overall approach to pre‐hospital care as well as for specific pre‐hospital interventions. The discussion will consist of an evidence‐based approach to the topic of pre‐hospital care and topics discussed will be based on past and current literature.